Overview of Clinical Rotations

PGY-1

The clinical rotations and course curriculum in the PGY-1 year foster the resident’s developing identity as a competent and caring physician, through rotations in medicine, neurology and psychiatry that offer broad clinical experience, excellent teaching, and appropriate levels of responsibility. In addition, residents begin to develop knowledge and skills in the diagnosis, management and treatment of severely disturbed and mentally ill inpatients. PGY-1 year is divided into six months of medicine and neurology, four months of adult inpatient psychiatry, and two months of rotations on the consult/liaison and ECT services. Residents take call at The University of Chicago Hospitals while on psychiatry, covering the Emergency Room and the general hospital for psychiatric emergencies, and providing supervision for emergent care issues arising on the University of Chicago inpatient psychiatry service at Mercy Hospital. Senior residents and faculty provide supervision to the on-call resident, initially on-site one-on-one back-up, and later, as the resident develops confidence and expertise, supervision by phone.

Medicine/Pediatrics and Neurology: Most residents spend two months on the inpatient general medicine service, one month on the general medicine consult service, and one month in the emergency department at the University of Chicago. Residents spend two months on the neurology service at the University of Chicago.  Those residents who have a particular interest in child psychiatry may choose to spend up to two months on the pediatrics service, and/or one month on the child neurology service at The University of Chicago Comer Children’s Hospital

Northshore University Adult Inpatient Psychiatry: Two months each during PGY-1 and PGY-2 year are spent on the adult inpatient psychiatric service.  Locased in Evanston, Northshore is a large and outstanding community hospital with strong ties to the University of Chicago.  The patient population is economically and diagnostically varied and includes some patients receiving ECT. 

Mercy Hospital Inpatient Psychiatry: Two months each during PGY-1 and PGY-2 year are spent on the adult inpatient psychiatric service. This general psychiatry unit treats acute patients with all major psychiatric disorders, as well as patients with comorbid substance abuse and dependence, and those with some comorbid medical problems. Patients come from the University community of students and faculty, from the varied communities on the South Side of Chicago and those surrounding Mercy Hospital, and transfers from the University of Chicago emergency room, inpatient medical/surgical, and outpatient psychiatric services.  Residents provide ECT for appropriate patients at Mercy Hospital.

Consultation/Liaison: Two months each during PGY-1 and PGY-2 year are spent on the C/L service at The University of Chicago. The C/L service provides consultation to all medical and surgical services in the general hospital. This service performs more than 700 new consults per year.  Residents from Neurology and Anesthesia Pain Fellows also rotate on the service. The C/L service hosts an interdisciplinary case conference at which medicine, surgery and specialty services such as the ethics service can discuss with psychiatry particular cases around which there has been consultation.

PGY-2

The PGY-2 year builds on the PGY-1 experiences in medicine and psychiatry, exposing residents to inpatient and outpatient psychiatric treatment in academic, public and private settings with more complex, dually diagnosed and medically complex patients.  Residents spend two months each on inpatient psychiatry at Mercy Hospital, inpatient psychiatry at Northshore University, and on the C/L service at the Universtiy of Chicago.  Residents also spend two months on each of the following services:  University of Chicago Emergency Psychiatric Service, Chemical Dependency at Chicago Lakeshore Hospital, and Community Psychiatry, an outpatient rotation at Thresholds. PGY-2 residents develop skills as psychiatric educators through increased responsibility for the teaching and supervision of medical students, and through coursework and supervision on education and educational techniques. Residents take call at the University of Chicago.

Chemical Dependency: Residents spend two months on the Chemical Dependency service at Chicago Lakeshore Hospital, under the direction of Dr. Martin Paisner, where patients are admitted for detoxification from a variety of substances of abuse. Residents participate in groups and individual treatment for addictions, attend AA meetings, become familiar with detoxification protocols, and managment of patients with dual diagnoses.

Community Psychiatry: Residents spend two months at Thresholds, one of the nation's largest non-profit providers of mental health services. Thresholds offers case management, education, job training and placement, housing, and operates Assertive Community Treatment (ACT) teams providing services to people with serious and persistent mental illness. Residents evaluate new patients and function as part of a team, providing outreach to people in the community in their homes and on the streets as well as in clinics.

Emergency Psychiatry: Residents spend two months on our Emergency Psychiatry service under the direction of Dr. Marie Tobin. Residents provide consultation to the emergency department for managment and recommendations on disposition for psychiatric emergencies.

Outpatients: Residents are expected to treat three outpatients per week during the PGY-2 year in weekly psychotherapy. Patients are referred from The University of Chicago student health service, as well as the outpatient clinics and inpatient units at The University of Chicago and Mercy Hospital. Residents have two hours of individual supervision, provided by faculty within the Department and at SCRS, the Student Counseling Resource Center on campus. Residents also rotate through the Continuing Care Clinic at the Univerisity of Chicago, which provides ongoing medication management, emergency drop-in services, and a large group experience for many patients with severe and persistent mental illness, serious economic and social problems, and major needs for rehabilitation services. This clinic works collaboratively with Thresholds.

PGY-3

The PGY-3 year is exclusively an outpatient year. Designed to enable residents to function more independently and to follow a large number of patients longitudinally, PGY-3 provides year-long experience in the general psychiatry clinics, several half-day sessions set aside to see psychotherapy patients, and six-month rotations in subspecialty clinics. Subspecialty clinics include neuropsychiatry, geriatrics, child psychiatry, addictions, anxiety disorders, personality disorders, refractory affective disorders, and several medical/psychiatric clinics including a transplant clinic and a psycho-oncology clinic . Residents provide teaching and supervision for medical students and provide back-up for PGY-1 and PGY-2 residents who take call.

The General Clinics: Adult patients are referred to our clinics from within the University of Chicago system, from inpatient stays on our inpatient psychiatry service, from the surrounding community of Hyde Park where students and faculty live, from the population of hospital and university employees, and from the South Side of Chicago and the greater Northern Indiana area. Problems vary from complex diagnostic issues to more common affective, anxiety and adjustment disorders. Residents are assigned to one general clinic per week, performing intakes and providing psychiatric follow-up to many patients for the PGY-3 and PGY-4 year.  The clinics are designed to enable residents to pick up a large caseload of patients with varied diagnoses and treatments.  Residents follow some patients in long-term psychodynamic psychotherapy, offer Cognitive Behavior Therapy to others, follow some family or couples cases, conduct a long- or short-term group, and have ample opportunity to work collaboratively with psychologists in coordinated treatment.  Faculty include Drs. Judith Badner, Deborah Spitz, and Daniel Yohanna.

Specialty Clinics: Residents rotate for six months in a variety of specialty clinics:

  • Child Psychiatry—directed by Drs. Sharon Hirsch, Karam Radwan, and Khalid Afzal, residents provide diagnostic assessment and treatment for patients with pervasive developmental disorders, disorders of attention, affective disorders, anxiety disorders, psychosis, and eating disorders.
  • Geriatrics—directed by Dr. Danielle Anderson, residents evaluate and manage disorders of mood, cognition, and psychosis in the geriatric population at University of Chicago and at the Univeristy of Chicago's South Shore Clinic, which offers integrated geriatric medical and psychiatric care.
  • Neuropsychiatry—directed by Dr. Joseph Cooper, this clinic treats patients with complex neuropsychiatric problems including movement disorders, neurodegnerative disorders, epilepsy, MS, traumatic brain injury as well as conversion disorders.
  • Anxiety Disorders—directed by Dr. Emil Coccaro and staffed by a psychologist and psychology trainees as well as by residents, this clinic serves patients with severe anxiety disorders, obsessional disorders, panic disorders and other comorbid psychiatric problems. It offers comprehensive evaluation and neuroimaging, pharmacologic treatment, and CBT.
  • Medical/Psychiatry—directed by Drs. Marie Tobin and Michael Marcangelo, who attend on the psychiatric consultation/liaison service at the University of Chicago, these clinics offer evaluation and follow-up to patients seen on the C/L service and other patients with comorbid medical and psychiatric problems. Specialized clinics include Transplant with Dr. Marcangelo, and Psycho-oncology with Dr. Tobin.
  • Personality Disorders—directed by Dr. Royce Lee, this clinic offers assessment and treatment to complex patients with personality disorders and often comorbid affective disorders.
  • Refractory Affective Disorders—directed by Dr. Eliot Gershon, this clinic offers highly specialized treatment for patients with severe and refractory unipolar and bipolar disorders. It offers residents the opportunity to use sophisticated psychopharmacologic interventions and gain an understanding of the long-term evolution of severe affective illness.
  • Student Counseling Resource Center (SCRS)—under the direction of Dr. Erin Burke, SCRS provides emergency consultation, psychoeducation, psychotherapy and medication management for undergraduate and graduate students at the University of Chicago.

Outpatients: In addition to patients followed within the general and subspecialty clinics, residents are expected to follow eight hours of outpatients in various modalities of psychotherapy, including psychodynamic psychotherapy, supportive psychotherapy, CBT, combined pharmacologic and psychological treatment, and family therapy. Residents are expected to lead or co-lead at least one group, which may be time-limited and focused on a particular diagnostic issue or problem, or open-ended.  Residents receive two and a half hours per week of individual supervision, and additional supervision is available for family and marital cases as well as individual cases for those who request it.

PGY-4

In the PGY-4 year, residents solidify administrative and leadership skills, enlarge clinical confidence and autonomy, and focus on individual specialized areas of interest. Each resident assumes a Chief Resident position with significant administrative, supervision and teaching components. Each resident completes a research project and makes a presentation to the Department. Residents continue to follow outpatients in a variety of psychotherapeutic modalities, and may choose elective clinical experiences in specialized psychotherapies, such as group or family therapy, psychodynamic psychotherapy, or dialectical behavior therapy, to name a few. All residents gain experience on our Electroconvulsive Therapy service and can choose to spend more time, if desired. In conjunction with faculty advisors, each resident develops an individualized schedule for the fourth year that reflects the serious pursuit of particular interests. Some residents choose to focus on research, some emphasize clinical experiences, others assume increased teaching responsibility. The year is designed to allow maximum flexibility so that each resident may pursue a meaningful area in depth.

Chief Residencies: One chief resident serves as Administrative Chief resident, leading Residents’ Meeting and working closely with the Residency Training Director on administrative issues. Chief residents on the Mercy inpatient unit, the consultation/liaison service, and the emergency service at The University of Chicago Hospitals provide administrative leadership, teaching and supervision for medical students and junior residents on those services, leading case conferences and morning report and designing and teaching specialized courses. There is flexibility in each of these roles, and specific duties may be negotiated with the Program Director, based on the resident’s interests; for example, one fourth year resident devised a Chief residency in Medical Student Education, helping to redesign the psychiatry clerkship and focus on recruitment of medical students into psychiatry.

Research: Under the supervision of faculty research mentors and with the guidance of the Research Seminar led by the Chair, Dr. Emil Coccaro, each resident completes a research project in collaboration with one of several research groups in the Department. The resident presents the research to the Department in December of the PGY-4 year. With feedback and discussion following that presentation, each resident writes up the research as a publishable paper. Some residents choose to spend a large portion of the PGY-4 year on larger research projects.

Forensic Psychiatry: PGY-3 and PGY-4 residents evaluate and write up forensic cases under the direction of one of the Department’s forensic psychiatrists, Dr. Steve Dinwiddie or Dr. Daniel Yohanna.

Elective ClinicAL Experiences:

Specialty Clinics: Resident can choose to spend six months in any of the above speciality clinics that they didn't experience in PGY-3.

Electroconvulsive Therapy: Under the direction of Dr. Joseph Cooper, residents gain experience in the outpatient evaluation of patients referred for ECT, the indications and relative contraindications for ECT, the informed consent process, the delivery of treatment and ongoing monitoring of psychiatric, cognitive and medical symptoms during and acute course of ECT, as well as the indications for long-term maintainence ECT.  For interested residents, an extended experience in ECT, leading to a certification of competence in ECT upon graduation, is available.

Intensive Sequence Elective: In conjunction with a course which reviews classic psychoanalytic theory under the direction of Dr. Harry Trosman, a senior psychoanalyst, the resident treats 2-3 patients for one year in intensive (two or three times per week) psychotherapy, with supervision provided by psychoanalysts affiliated with the Chicago Institute for Psychoanalysis.

Family Institute Elective: Residents take courses and evaluate and treat families at the Family Institute in Downtown Chicago.

Other Electives: Clinical, research and educational electives are arranged individually.